Metformin alone compared with placebo increases the ovulation rate in women with polycystic ovary syndrome (PCOS) but should notbe used asfirst-line therapy for anovulation because oral ovulation induction agents such as clomiphene citrate or letrozole alone aremuch more effective in increasing ovulation, pregnancy, and live-birth rates in women with PCOS. There is fair evidence that metforminalone does not increase rates of miscarriage when stopped at the initiation of pregnancy and insufficient evidence that metformin incombination with other agents used to induce ovulation increases live-birth rates. (Fertil SterilÒ2017;108:426–41.Ó2017 by AmericanSociety for Reproductive Medicine.)
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